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Hepatitis A Statewide Community Outbreak
Hepatitis A Statewide Community Outbreak

The Ohio Department of Health (ODH) declared a statewide community outbreak of hepatitis A in June 2018 after observing an increase in cases. Hepatitis A is a vaccine-preventable liver disease that usually spreads when a person ingests fecal matter ― even in microscopic amounts ― from contact with objects, food or drinks contaminated by the stool of an infected person. Hepatitis A can also be spread from close personal contact with an infected person, such as through sex. The statewide community outbreak is spread through person-to-person contact.

In May 2019, the Centers for Disease Control and Prevention (CDC) provided an updated case definition resulting in an increase in the number of outbreak cases in Ohio. ODH and local health departments continue to investigate reported hepatitis A cases.

The high-risk populations for hepatitis A in this outbreak include:

  • People who use drugs (injection or non-injection).
  • People experiencing unstable housing or homelessness.
  • People who are currently or were recently incarcerated.
  • Men who have sex with men (MSM).
  • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C.

Symptoms of hepatitis A include fatigue, low appetite, stomach pain, nausea, clay-colored stools and jaundice. People with hepatitis A can experience mild illness lasting a few weeks to severe illness lasting several months.

People who believe that they are at high risk for hepatitis A infection should contact their healthcare provider or local health department for information about vaccination. People who know that they have been exposed to someone with hepatitis A should contact their healthcare provider or local health department to discuss post-exposure vaccination options. Individuals who experience symptoms of hepatitis A should contact their healthcare provider. Find a local health department in Ohio.

Outbreak Case Statistics

(Information will be updated each Monday by 2 p.m.)

Hepatitis A Outbreak Map 07262021

Ohio Hepatitis A Outbreak Cases by County (July 26, 2021):

County Total County Total
Adams 22 Logan 4
Allen 10 Lorain 17
Ashland 4 Lucas 27
Athens 63 Madison 6
Auglaize  8 Mahoning 10
Belmont 15 Marion 62
Brown 10 Medina 25
Butler 410 Meigs 13
Carroll 1 Mercer 5
Champaign 9 Miami 38
Clark 77 Monroe 1
Clermont 111 Montgomery 283
Clinton 22 Morgan 2
Columbiana 4 Morrow 25
Coshocton 6 Muskingum 57
Cuyahoga 184 Noble 14
Darke 25 Ottawa 3
Delaware 15 Paulding 1
Erie 15 Perry 27
Fairfield 73 Pickaway 75
Fayette 13 Pike 46
Franklin 472 Portage 28
Fulton 2 Preble 46
Gallia 40 Putnam 2
Geauga 3 Richland 9
Greene 34 Ross 85
Guernsey 10 Sandusky 3
Hamilton 279 Scioto 94
Hancock 7 Seneca 2
Hardin 2 Shelby 2
Harrison 8 Stark 33
Henry 2 Summit 161
Highland 27 Trumbull 25
Hocking 12 Tuscarawas 38
Holmes 3 Union 5
Huron 2 Vinton 14
Jackson 48 Warren 81
Jefferson 35 Washington 53
Knox 27 Wayne 47
Lake 15 Wood 5
Lawrence 81 Wyandot 5
Licking 69    
Grand Total     3,754

 

Ohio Hepatitis A Outbreak Summary (July 26, 2021):

  • Number of cases: 3,754.
  • Illness onset range: Jan. 5, 2018 – July 20, 2021.
  • Age range: 1-90 years.
  • Gender: 61% male.
  • Number of hospitalizations: 2,339 (62%).
  • Number of deaths: 16.
  • Number of counties with cases: 83 (94%).

 

Ohio Hepatitis A Outbreak Case Definition:

CLINICAL CRITERIA

An acute illness with a discrete onset since Jan. 1, 2018, of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea and abdominal pain),

AND

  • Jaundice or elevated total bilirubin levels ≥3.0 mg/dL, OR
  • Elevated serum alanine aminotransferase (ALT) levels (>200 IU/L)

AND

  • The absence of a more likely diagnosis

LABORATORY CRITERIA

  • Immunoglobulin M (IgM) antibody to hepatitis A virus (anti-HAV) positive, OR
  • Nucleic acid amplification test (NAAT; such as PCR or genotyping) for hepatitis A virus RNA positive

CONFIRMED CASE

  • A case that meets the clinical criteria and is IgM anti-HAV positive, OR
  • A case that has hepatitis A virus RNA detected by NAAT (such as PCR or genotyping), OR
  • A case that meets the clinical criteria and occurs in a person who has an epidemiologic link (household contact, drug partner, or sexual contact) with a laboratory-confirmed hepatitis A case 15–50 days prior to onset of symptoms

EXCLUSIONS

A case will be excluded if any of the following conditions apply:

  • In the absence of known risk factors (injection or non-injection drug use, men who have sex with men, homelessness, or incarceration), any case that occurs in a patient who reports travel to a country or U.S. territory with endemic hepatitis A during the 15-50 days before symptom onset, OR
  • Any case that is linked to a foodborne outbreak by related sequencing, OR
  • In the absence of known risk factors (injection or non-injection drug use, men who have sex with men, homelessness, or incarceration), any case that is epi-linked to a foodborne outbreak, OR
  • Any case with a specimen collected within four weeks of symptom onset that is negative for HAV RNA

 

For more information, please call the Ohio Department of Health Bureau of Infectious Diseases at (614) 995-5599.